MEDICARE: TARRY ADAIR BUTNER P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	15636	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E273 0003	OTHER	MD	GHMSI & BCBS FEERAL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	IWIF 25-99	OTHER	MD	INJURED WORKERS'
4	11937	OTHER	MD	PRIORITY PARTNERS
5	60405501	OTHER	MD	CAREFIRST BCBS
6	15636	OTHER	MD	LICENSE #
7	258607	OTHER	MD	ALLIANCE/MD.IPA/OPTIMUM C

General Provider Information

NPI Number	:	1861579666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARRY ADAIR BUTNER P.T.

Provider Business Mailing Address
First Line	:	13141 GARRETT HWY
Second Line	:
City	:	OAKLAND
State	:	MD
Zip	:	21550-1164
Country	:	US
Telephone Number	:	301-334-5220
Fax Number	:	301-334-6277

Provider Business Practice Location Address
First Line	:	13141 GARRETT HWY
Second Line	:
City	:	OAKLAND
State	:	MD
Zip	:	21550-1164
Country	:	US
Telephone Number	:	301-334-5220
Fax Number	:	301-334-6277

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	03/20/2008

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Directions to “ TARRY ADAIR BUTNER P.T.” Practice Location

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